| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,492 |
3,453 |
$299K |
| D0220 |
Intraoral - periapical first radiographic image |
2,502 |
2,476 |
$48K |
| D1120 |
Prophylaxis - child |
3,329 |
3,295 |
$45K |
| D1351 |
Sealant - per tooth |
1,246 |
306 |
$34K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
257 |
161 |
$18K |
| D2140 |
|
271 |
192 |
$17K |
| D1206 |
Topical application of fluoride varnish |
3,613 |
3,577 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,343 |
2,271 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
63 |
63 |
$6K |
| D0272 |
Bitewings - two radiographic images |
1,558 |
1,532 |
$6K |
| D0274 |
Bitewings - four radiographic images |
549 |
539 |
$3K |
| D1110 |
Prophylaxis - adult |
97 |
97 |
$2K |
| D9248 |
|
12 |
12 |
$1K |
| D0330 |
Panoramic radiographic image |
58 |
58 |
$728.23 |
| D0240 |
|
26 |
13 |
$0.00 |